摘要
Abstract
Objective To investigate the risk factors for pulmonary hemorrhage in very low birth weight infant(VLBWI)and to establish a prediction model.Methods A retrospective analysis was conducted on the clinical data of 142 VLBWI cases admitted to the First Affiliated Hospital of Anhui Medical University from October 2016 to October 2023,and they were divided into the pulmonary hemorrhage group(63 cases)and the non-pulmonary hemorrhage group(79 cases)according to the diagnostic criteria of neonatal pulmonary hemorrhage.Clinical characteristics,and coagulation and blood gas analysis indexes were collected,and a univariate analysis was performed before incorporating multifactorial logistic regression to analyze the high risk factors,constructing a prediction model,and evaluating the VLBWI pulmonary hemorrhage prediction model through the receiver operator characteristic(ROC),calibration,and decision curves.Results Comparison showed no statistically significant differences in gender,cesarean section,abnormal amniotic fluid volume,contaminated amniotic fluid,placental abnormality,umbilical cord abnormality,artificial insemination,and tracheal intubation between pulmonary hemorrhage group and the non-pulmonary hemorrhage group(P>0.05).There were statistically significant differences in birth weight,gestational age,use of pulmonary surfactant(PS),premature rupture of membranes>18 hours,use of prenatal glucocorticoids,hypoalbuminemia,1 minute Apgar score,5 minutes Apgar score,prothrombin time,prothrombin activity,international normalized ratio,activated partial thromboplastin time(APTT),fibrinogen,partial pressure of carbon dioxide,HCO3-,total carbon dioxide,and ionized calcium(iCa)between the two groups(P<0.05).Multifactorial logistic analysis showed that use of prenatal glucocorticoids and iCa were protective factors for the development of pulmonary hemorrhage in VLBWI,and use of PS and APTT were independent risk factors for the development of pulmonary hemorrhage in VLBWI(P<0.05).The above four independent factors were included in the final model,and the area under the ROC curve was 0.811.Conclusion The occurrence of pulmonary hemorrhage in VLBWI is associated with the use of prenatal glucocorticoids in mothers,the use of PS in neonates,prolonged APTT and low iCa,and the prediction model constructed by using these factors can help clinicians to identify high-risk groups of pulmonary hemorrhage at an early stage,and provide important reference information for clinical diagnosis and treatment,which has a certain predictive effect on the occurrence of pulmonary hemorrhage.关键词
肺出血/极低出生体重儿/糖皮质激素/肺表面活性物质/活化部分凝血活酶时间/游离钙Key words
Pulmonary hemorrhage/Very low birth weight infant/Glucocorticoid/Pulmonary surfactant/Activated partial thromboplastin time/Ionized calcium分类
医药卫生
